Washington Providers Request For Adjustment is a form used by health care providers in Washington state to request reimbursement from the state's Health Care Authority (HCA) for services rendered to Medicaid or Apple Health (Medicaid expansion) enrolled. The form is used to submit a request for an adjustment to the amount paid, or to request an additional payment for services rendered. There are three types of Washington Providers Request for Adjustment: 1) Adjustment Request for Underpayment, 2) Adjustment Request for Overpayment, and 3) Adjustment Request for Additional Payment. The Adjustment Request for Underpayment is used when a provider believes that they have been underpaid for services rendered to a Medicaid or Apple Health enrolled. The Adjustment Request for Overpayment is used when a provider believes that they have been overpaid for services rendered to a Medicaid or Apple Health enrolled. The Adjustment Request for Additional Payment is used when a provider requests payment for additional services rendered to a Medicaid or Apple Health enrolled that have not been previously billed or paid.
Washington Providers Request For Adjustment
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General information. Contact the Washington State Department of Labor & Industries for information about agency programs and services in your language at 1-800-547-8367. Once you are on the phone, please hold a moment while we call an interpreter to help us.
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